TVAR Coding

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Good Morning. We recently started to perform TVAR procedures. I am hoping someone who is already doing these can assist in a question I have regarding femoral cutdown. The manufacturer is recommending 36140 which is not a cutdown approach. Are you billing 34812 or 36625? Have you had any luck in getting the cutdown paid?

Thank you for your help. I look forward to your reply.

Monica
 

jewlz0879

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We bill the TAVR's a lot but my Cardio is always just an assist so I have not billed for the cutdown. I'm not sure if there is any direction on this. Aside from that, I think 34812 is the best code for the cutdown but I've only billed it with Endovascular AAA's. Maybe you could bill it with a few (in the event you don't find a direct answer or direction) and see what happens. Follow those clms and see if they pay, if not, the denial reason. It doesn't seem like the cutdown has been included with the 0257T.
 
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Julie,
Thank you for your reply. I went to 34812 instinctually but when we have billed it with 33880-33881 in the past we have been denied for it only applying to the AAA endograft procedure. I went back to the company rep & she said their coding consultant recommended 36415, which is a venopunture/lab code. The Q&A from the company states a cutdown can be billed and I'm not finding it in the CCI edits. I'm just trying to ward off back end reviews since that is handled by an off site group. I have a call out to STS & I'm hoping to hear back before end of month. If I get an answer, I'll let you know. Thanks again.

Monica J. Holodnik, CPC
 

jewlz0879

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Yea 36415 and 36140 are not going to cut it (no pun intended). LOL! I thought it might be denied for that. I guess it's just included? 22 is probably not appropriate either.

That would be awesome. Thanks!
 

MLS2

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Tvar

When you say cut-down, you are referring to the open femoral/brachial exposure for deployment of the endograft correct? if so, 34812 would be correct for a femoral cut-down/exposure.

pg. 183 of the CPT book gives an explanation of rules specific to TVAR coding.

"open arterial exposure and associated closure of the arteriotomy sites (eg, 34812, 34820, 34833, 34834), introduction of guidewires and catheters (eg, 36140, 36200-36218), and extensive reapir or replacment of an artery (eg, 35226, 35286) should be additionally reported."
 
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